SPINAL EPIDURAL ABSCESS AS A COMPLICATION OF STAPHYLOCOCCUS AUREUS BACTEREMIA

Spinal epidural abscess as a complication of Staphylococcus aureus bacteremia A pyogenic spinal epidural abscess is a bacterial infection in the epidural space that results in the accumulation of purulent fluid or infected granulation tissue. Predisposing factors include immunosuppression, spinal procedures, and local site infections such as vertebral osteomyelitis and paraspinal abscess. Here we present a case with Staphylococcus aureus bacteremia complicated by meningitis and spinal abscess. A 6 month old child presented with a 1 month history of fever and discomfort. Dizziness and lethargy were observed 2 days before admission. He had a history of otitis media and bronchiolitis. A lumbar puncture was performed revealing 850 leukocytes (90% neutrophils), protein 2 g/l, and glucose 5 mmol/l in cerebrospinal fluid (CSF) examination. Vancomycin and ceftriaxone were iniated with a diagnosis of acute bacterial meningitis (ABM). Staphylococcus aureus was isolated from both blood and CSF cultures. Ceftriaxone was stopped and rifampicin was added to vancomycin. He had mild weakness noted on right hand. Magnetic resonance imaging (MRI) of brain and spinal cord revealed extensive epidural abscess at cervical, thoracal, and lumbosacral spinal regions. Dermal sinus tract or granulomatous otitis were not identified as predisposing factors. Blood samples from the father and the patient were studied for dihydrorhodamine 123 (DHR) test but were not compatible for chronic granulomatous disease (CGD). Serum immunoglobulins and lymphocyte subset analysis were normal. Surgical decompression was performed. Antibiotics were modified as ampicillin-sulbactam since the isolate was found to be methicillin susceptible (MS. Clinical condition of the patient improved. Community-acquired MSSA meningitis is a serious infection, occurring in patients without risk factors. Hematogenous dissemination may lead to multiple tissue infection. A long course of antibiotics is needed to treat meningitis but also extraneurological localizations.